| NPI | 1972394260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 175T00000X Peer Specialist (Licence: CA ZMTODN) | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2026-07-06 |